Basic Bioethical Principles

7/31/2019 Basic Bioethical Principles

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ETHICO-LEGAL ASPECTS

IN MATERNAL &CHILD CARE

Mrs. Ma. Imelda O. Javier, RN, MAN


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Basic Ethical Principles STEWARDSHIP

Our bodies, our life, our human nature and

everything in this earth are gifts we havedominion over. This means we areresponsible for them. We should not, asfaithful stewards, harm but rather improve

and care for them. We have to treat themwith utmost respect, use originality andcreativity to cultivate them, know and respecttheir limits. We cannot contradict human

nature.


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TOTALITY

Totality refers to thewhole. Every personmust develop, use, care for and preserve allhis partsand functions for themselves as

well as for the good of the whole. If a part orlower function harms the whole, this part orlower function may be sacrificed for the good or

better function of the whole. The basiccapacities which define human personhood,however, are sacrificed only when there is needto preserve life.


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DOUBLE EFFECT

When an act is foreseen to have both goodand bad effects, the principle of double effect

is applied. In order that such act bepermissible, the following conditions shouldbe met:

1. The action itself must be good or at leastneutral.


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COOPERATION

Cooperation is the participation of one agentwith another agent to produce a particulareffect or joint effect. Cooperation becomes aproblem when the action of the primary agent ismorally wrong.


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Cooperation may be:

1.A. Formal - when the secondary agentwillingly participates as when one agrees,advices, counsels, promotes, or condones.

B. Material when the secondary agent does

not willingly participate2.A. Immediate when the action of the

secondary agent is inherently bound to theperformance of the evil action

B. Mediate when the action of the secondaryagent is not inherently bound to theperformance of the evil action.


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Formal cooperation is not allowed.

Material immediate cooperation is also as a

rule not allowed. When there is significantreason, and scandal is avoided, materialmediate cooperation, may be permitted taterharm.


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SOLIDARITY

Solidarity means to be one with others. Inthe provision of health care, it is most

important for the provider to be in solidaritywith the patient when seeking, always, thelatters best interest. In a country like thePhilippines, this is most important while

dealing with the poor, the uneducated, thedisadvantaged and the marginalized. They arethe ones most in need of the concernedhealthcare provider.


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Major Bioethical Principles

RESPECT FOR PERSON

Respect for person is the recognition of theequality possessed by every human being as aunique, worthy, rational, self-determining creature,having the capacity and right to decide what is bestfor himself. It is not undermined by states ofsuffering, disability or disease


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Respect for person is the responsibility of all totreat persons as an end and never as a means.

Respect for person is manifest in:

autonomy(self-governance)

right of non-interference.allowed to determine his own destiny.

to deliberate about his plans.

choose according to his own values.

act accordingly.

allowed to be his own person without constraintsfrom the actions of others or from physical orpsychological limitations.


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X has a right to determine his course of action

Y has an obligation not to constrain X.

This is best practiced in the principle offree andinformed consent.


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JUSTICE

Justice, also termed fairness, means to give toeach one what he deserves or what is his due.

X has a right to his due

Y has the obligation not to deprive X of

his due.

But man lives in a finite world. There are limitsto funds, medical supplies, healthcare services.The needs of everyone, even if it is his due,

cannot all be served.


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Justice also means to treat equals equally.

X & Y are equal

X & Y should have equal benefits/burdens

Issues arise in deciding who is equal, in the criteriato determine equality and in, who should make

these decisions.


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Creating a healthcare policy helps decide how

limited resources are to be distributed.It should consider the principles of:

equality (distributive justice)

social justice solidarity

The policyshould state in clear terms the criteriafor consideration, rank ordering, etc. and this should

be made public.


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THE INVIOLABILITY OF LIFE

The principle of inviolability of life is alsoproposed as the sanctity, the dignity or respectfor human life.

From the Judeo Christian tradition human lifehas dignity because life is Gods gift. Man

comes directly from God, is created according toGods plan and destiny. It is God who is thesource, who sustains and perfects mans life.


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The principle of the inviolability of human life

means that life, in itself is sacred. It not to be

violated, opposed or destroyed but is to be

affirmed, cherished, respected, and preserved.

Commitment to the principle of the inviolability of

life means choosing life and fighting to protect it.

Commitment to life overcomes commitment todeath.


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It is to be against violence, pollution ofenvironment, drug and alcohol addiction,treachery in human relations.

X has a right to life

Y has a duty NOT to kill X.

The principle also includes measures for thesurvival of the human species, and thefreedom to have children.


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NON MALEFICENCE

Non maleficence means to do no, to prevent, toremove or not to risk harm.

X has a right not to be harmed.Y has an obligation not to harm X

Harm may be physical, mental, psychological,social, financial, spiritual, etc.


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BENEFICENCE

Beneficence is the positive pole ofnonmaleficence. It means to do good, toprovide a benefit. Beneficence hinges on otherduties such as fair play, keeping promises, role

commitments, reciprocity.

Applied together with nonmaleficence it entails

weighing benefits versus burdens thenchoosing the action that brings the mostbenefit and the least burden to thoseaffected. This is the principle of utility.


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APPLIED HEALTH ETHICS

INFORMED CONSENT

Informed consent is an ideal connected to the

principles ofautonomy and respect for person.Any procedure to be done on a person may onlybe administered with his free and informedconsent. This givesvalid permission for others

to act in certain specific ways.


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Originally introduced in the context of research toavoid abuse on research subjects, it was a meansto morally justify the burdens and risks given to themby their agreement to accept such burdens/risks.

Recognizing that every person is primarilyresponsible for his own body, free and informedconsent was later introduced into patient care as a

means of protecting a patients personalintegrity and enhancing the patients active rolein his own care.


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Informed consent therefore has two mainfunctions:

1. Protective - to safeguard against intrusion ofintegrity.

2.Participative to be involved in medical

decision making.

With the introduction of informed consent in

healthcare, there has been a shift from the

paternalism of doctor knows best anddecides to patient knows best anddecides.


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Elements of Informed Consent

1. Knowledge

1.1. Information disclosure by the healthcaregiver: The truth of the proposed action,its nature, probable benefits, possible risksand alternative options or information

relevant to a meaningful decision makingprocess must be given to the patient.


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1.2. Comprehension by the subject. Theinformation must be given in words andmanner that can be easily understood bythe subject. Distorted, unfamiliar andunsuitable information, poor

information processing, overload,selective perception, etc. must beavoided. It may lead the subject to acceptthe information given without appreciatingit.


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2. CONSENT

2.1. Subject competence: The subject must beable to make decisions based on rationalreasons.

2.2. Subject freedom. The subject must be ableto choose and act without undue pressureof time, emotional upset, confusion,persuasion, coercion, threat, deception,

manipulation, fear or other forms of controlby others.


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When informed consent cannot be given by thepatient, the patients family or guardian orrepresentative provides it. This is proxy consent.

Decisions by the proxy should be based on whatthe patient would have chosen had he beencompetent or it the patients preferences are notknown, based on the patients best interest.


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THE BEGINNING OF LIFE

Both the Catholic Church and the PhilippineConstitution recognize the sacredness of life fromthe time of conception. From fertilization throughfetal life, until birth the human being must beprotected. Equally important is the respect fordignity of parents and new born expressed in themethod new life is created. A child must be the fruit

of the conjugal union between husband and wife.


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THE END OF LIFE

Life is a gift, which, as good stewards, we have toprotect and defend. But life can be sustained for

only so long; ultimately, death claims us all.Furthermore, life is not the highest value and canbe given up for higher values.


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Many healthcare providers have difficultiesaccepting death and managing the dying patient.They see death as a failure of treatment, areinfluenced by the technologic imperative to use

everything available, are more comfortabletreating than not treating and hesitate tobring the bad news of his condition to thedying patient.


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Every healthcare provider must learn to face death

and help his patient accept death when dying isthe only option open. No one needs to dieneglected, alone, shunted aside by disease,hooked on tubes and to machines, or isolatedfrom families and loved ones.

Death with dignity, humane death and a gooddeath must be available. An environment mustbe created wherein the patient, his family, andthe healthcare providers can accept death calmlyand peacefully with the knowledge thatappropriate care is being given.


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They must be assured that the patientwill notbe abandoned and that he is forgiven for

dying.

To attain these the health provider

therefore must:1. Communicate compassionately, tell bad newsearly enough to provide time for the patient to acceptit and make the best use of this most importantlimited time of his life: to say goodbye, settle materialmatters, to mend broken relationships, to express love,etc.


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2. Use technology prudently. Recognize the realmof medical futility and avoid disproportionatemeans to maintain life at all cost.

3. Relieve pain effectively. The dying man oftenfears dying with pain. It limits freedom andindependence, causes anxiety, rejection andmarginalization, and often robs a person of hisdignity and sense of identity.


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The healthcare provider must relieve pain effectively at

the same time accepting that intractable and severe pain

relief may necessarily decrease consciousness and evenrisk the shortening of life. He must also help the

patient understand the gift of pain and utilize pain

for good.

4. Approach the patient holistically; focusing onthe entire person; giving physical,psychological, mental, emotional, moral and

spiritual support. The dying patient is lonely,has needs, and worries about loss of control.


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The healthcare provider must provide palliative or

comfort care, minimize the patients symptoms, andmaximize his interaction with others. He should

provide support, protection and if possible, security,

pray for and with his patient.

In summary, the healthcare provider must be a

companion in his patients final journey, be in

solidarity with his patient, and be present to

receive the gift of dying.

Basic Bioethical Principles

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